Dyshidrotic epidermophyton is a fungal lesion of the dermis, localized mainly in the area of the palms and soles, preceding mycotic eczema. Clinically, it is manifested by a sudden rash of a finely bubbly transparent rash, changing due to the addition of a secondary infection to pustules with purulent contents. The process may be accompanied by a deterioration in the patient’s well-being: weakness, subfebrility, headache. Some of the primary elements shrink into crusts, some are opened, forming erosions: wetness begins with the outcome of pigmentation. Epidermophyton is diagnosed clinically using microscopy. Pathogenetic treatment, antifungal agents.
Dyshidrotic epidermophyton is a common contagious dermatomycosis. Infection is possible by contact with a sick person, by contact with infected household items. At risk are people who neglect to observe the rules of personal hygiene in public places (saunas, swimming pools, on the beach), suffering from excessive sweating (against the background of obesity, diabetes mellitus), forgetting that heat and moisture in combination with unsanitary conditions are the optimal environment for the development of fungus. Dyshidrotic epidermophyton has no age, gender, ethnic characteristics, but more often the male half of the population suffers from mycosis. In dermatology, the share of dyshydrotic epidermophytosis accounts for about 10% of all mycoses. The first mention of dermatophytes is found in the Roman physician Celsus in 25 BC, in 1839 D. Schonlein accidentally discovered fungi on the skin of a patient with “impetigo”, in 1841 D. Gruby established a connection between fungi and skin pathology.
The causative agent of dyshydrotic epidermophytosis is a fungus from the genus of epidermophytons, among which there are representatives of anthropophiles (human habitat), zoophiles (parasitize animals), geophiles (“live” in the soil). Accordingly, the ways of infection can be as follows: from person to person (the most common), from animals, through the soil. The fungus that causes dermatomycosis is saprophyte. It is constantly present on the surface of the skin, which, due to its protective functions, is a reliable barrier to its penetration into the human body. Under certain conditions, the transformation of a saprophytic microbe into a pathogenic origin occurs (constant sweating, calluses, a shift in the pH of the skin to the alkaline side, hypovitaminosis, decreased immunity, exacerbation of chronic ailments, high humidity, air temperature). If such a transformation coincides with a violation of the integrity of the skin (abrasion, burr, wound), fungi penetrate into the dermis, begin to multiply.
The immune system identifies epidermophytons and their waste products (toxins) as dangerous antigens. The production of antibodies binding “strangers” begins; the skin is sensitized, reacting with the appearance of symptoms of dermatomycosis. Over time, there are too many antibodies, which, against the background of a decrease in local and general immunity, can lead to the development of mycotic eczema. That is why many dermatologists consider dyshidrotic epidermophytosis to be the “forerunner” of mycotic eczema.
Dyshidrotic epidermophyton is characterized by damage to the epidermis, nails. In the area of the feet, palms, interdigital spaces, against the background of itching and unchanged skin, a grouped bubble rash appears. Each bubble the size of a sago seed is covered with a tight lid. The bubbles combine to form a cellular substance, exposing after opening a large erosion with a “cuff” of the cells of the remaining epithelium around the perimeter. The secondary infection that has joined causes hyperemia, the formation of pustules, and the reaction of regional lymph nodes.
After a month, the inflammation resolves, the erosions heal, forming a multi-layered scaly-squamous zone. After a couple of months, a slight pigmentation remains. If a relapse occurs, new skin areas are affected. Secondary allergic, polymorphic, symmetrical rashes appear – epidermophytids consisting of erythemas, vesicles, papules. Sometimes the fungal process affects the nails: they fade, become cloudy, thicken, become brittle, crumble, stripes and yellow spots appear on the surface of the plates.
Dyshidrotic epidermophyton is easily recognized by the clinic, microscopy data of skin scraping (the remains of the fungus in the scraping from the lesion are detected). Histological examination shows spongiosis, thickening of the epidermis, white blood cells are found in the vesicles. Lesions are studied in the rays of Wood’s lamp. Differential diagnosis is carried out with varieties of classical epidermophyton, mycotic eczema, pyoderma, contact dermatitis.
The main principle of therapy is a gradual transition from anti-inflammatory treatment in the acute period to antifungal treatment when the process is resolved. Vitamins (groups B, PP), antihistamines (clemastine) are used as background therapy, calcium chloride is used to reduce exudation. Careful treatment of the lesion and the area around it is the key to the success of external therapy; for this purpose, resorcinol, silver nitrate, aniline paints are applied to the previously opened bubbles. Antifungal drugs (undecylenic acid, miconazole), hormonal ointments are used to resolve the process. UVI, magnetotherapy is shown. In advanced cases, with nail damage, after consultation with a dermatologist, a complete detachment of the skin of the palms, feet is carried out according to Arievich with a preventive intake of griseofulvin.
Regular skin care, compliance with the rules of personal hygiene is the basis for the prevention of dyshydrotic epidermophytosis. Patients are subject to dispensary observation by a dermatologist or mycologist for a year. The prognosis is favorable.